/ /

  • linkedin
  • Increase Font
  • Sharebar

    Fever without a source, think UTI first

    Pediatricians should screen febrile infants for urinary tract infection (UTI) and other genitourinary diagnoses before treating fever and nonspecific symptoms with antibiotics.



    Urinary tract infection is sometimes difficult to diagnose in young pediatric patients. However, additional less-invasive testing may aid the pediatrician in identifying patients who are sicker or who need further diagnostics.


    1. Coulthard MG, Lambert HJ, Vernon SJ, Hunter EW, Keir MJ, Matthews JN. Does prompt treatment of urinary tract infection in preschool children prevent renal scarring: mixed retrospective and prospective audits. Arch Dis Child. 2014;99(4):342-347.

    2. Shaikh N, Mattoo TK, Keren R, et al. Early antibiotic treatment for pediatric febrile urinary tract infection and renal scarring. JAMA Pediatr. 2016;170(9):848-854.

    3. Shaikh N, Shope TR, Hoberman A, Vigliotti A, Kurs-Lasky M, Martin JM. Association between uropathogen and pyuria. Pediatrics. 2016;138(1):e20160087.

    4. Subcommittee on Urinary Tract Infection. Reaffirmation of AAP clinical practice guideline: the diagnosis and management of the initial urinary tract infection in febrile infants and young children 2-24 months of age. Pediatrics. 2016;138(6):e20163026.

    5. Subcommittee on Urinary Tract Infection; Steering Committee on Quality Improvement and Management; Roberts KB. Urinary tract infection: clinical practice guideline for the diagnosis and management of the initial UTI in febrile infants and children 2 to 24 months. Pediatrics. 2011;128(3):595-610.

    6. Baraff LJ, Bass JW, Fleisher GR, et al. Practice guideline for the management of infants and children 0 to 36 months of age with fever without source. Agency for Health Care Policy and Research. Ann Emerg Med. 1993;22(7):1198-1210.

    7. Gomez B, Mintegi S, Bressan S, et al; European Group for Validation of the Step-by-Step Approach. Validation of the “Step-by-Step” approach in the management of young febrile infants. Pediatrics. 2016;138(2):e20154381.

    8. Wettergren B, Jodal U, Jonasson G. Epidemiology of bacteriuria during the first year of life. Acta Paediatr Scand. 1985;74(6):925-933.

    9. Linshaw M. Asymptomatic bacteriuria and vesicoureteral reflux in children. Kidney Int. 1996;50(1):312-329.

    10. Lindberg U, Claesson I, Hanson LA, Jodal U. Asymptomatic bacteriuria in schoolgirls. VIII. Clinical course during a 3-year follow-up. J Pediatr. 1978;92(2):194-199.

    11. Hansson S, Martinell J, Stokland E, Jodal U. The natural history of bacteriuria in childhood. Infect Dis Clin North Am. 1997;11(3):499-512.

    12. Stoll ML, Rubin LG. Incidence of occult bacteremia among highly febrile young children in the era of the pneumococcal conjugate vaccine: a study from a children’s hospital emergency department and urgent care center. Arch Pediatr Adolesc Med. 2004;158(7):671-675.

    13. Shaikh N, Morone NE, Bost JE, Farrell MH. Prevalence of urinary tract infection in childhood: a meta-analysis. Pediatr Infect Dis J. 2008;27(4):302-308.

    14. Hsiao AL, Chen L, Baker MD. Incidence and predictors of serious bacterial infections among 57- to 180-day-old infants. Pediatrics. 2006;117(5):1695-1701.

    15. Roberts KB. Revised AAP guideline on UTI in febrile infants and young children. Am Fam Physician. 2012;86(10):940-946.

    16. Doern CD, Richardson SE. Diagnosis of urinary tract infections in children. J Clin Microbiol. 2016;54(9):2233-2242.

    17. Kass EH. Asymptomatic infections of the urinary tract. Trans Assoc Am Physicians. 1956;69:56-64.

    18. Kass EH. Pyelonephritis and bacteriuria. A major problem in preventive medicine. Ann Intern Med. 1962;56:46-53.

    19. Hoberman A, Wald ER, Reynolds EA, Penchansky L, Charron M. Pyuria and bacteriuria in urine specimens obtained by catheter from young children with fever. J Pediatr. 1994;124(4):513-519.

    20. Tullus K. Low urinary bacterial counts: do they count? Pediatr Nephrol. 2016;31(2):171-174.

    21. Montini G, Tullus K, Hewitt I. Febrile urinary tract infections in children. N Engl J Med. 2011;365(3):239-250.

    22. Leroy S, Fernandez-Lopez A, Nikfar R, et al. Association of procalcitonin with acute pyelonephritis and renal scars in pediatric UTI. Pediatrics. 2013;131(5):870-879.

    23. Leroy S, Romanello C, Galetto-Lacour A, et al. Procalcitonin is a predictor for high-grade vesicoureteral reflux in children: meta-analysis of individual patient data. J Pediatr. 2011;159(4):644.e4-651.e4.

    24. Gervaix A, Galetto-Lacour A, Gueron T, et al. Usefulness of procalcitonin and C-reactive protein rapid tests for the management of children with urinary tract infection. Pediatr Infect Dis J. 2001;20(5):507-511.

    25. Mantadakis E, Plessa E, Vouloumanou EK, Karageorgopoulos DE, Chatzimichael A, Falagas ME. Serum procalcitonin for prediction of renal parenchymal involvement in children with urinary tract infections: a meta-analysis of prospective clinical studies. J Pediatr. 2009;155(6):875.e1-881.e1.

    26. Gomez B, Bressan S, Mintegi S, et al. Diagnostic value of procalcitonin in well-appearing young febrile infants. Pediatrics. 2012;130(5):815-822.

    Pat F Bass III, MD, MS, MPH
    Dr Bass is Chief Medical Information officer and professor of Medicine and of Pediatrics, Louisiana State University Health Sciences ...


    You must be signed in to leave a comment. Registering is fast and free!

    All comments must follow the ModernMedicine Network community rules and terms of use, and will be moderated. ModernMedicine reserves the right to use the comments we receive, in whole or in part,in any medium. See also the Terms of Use, Privacy Policy and Community FAQ.

    • No comments available


    Latest Tweets Follow